Patna: Bihar’s public healthcare system, which has already been strained by the life-threatening novel coronavirus pandemic, has been struck by another complication: the Acute Encephalitis Syndrome (AES).
AES has already hit the district of Muzaffarpur and one death and four cases have been reported thus far.
Three-year-old Aditya Kumar from the Baiju Bujurg village under the Sakra block of Muzaffarpur district was admitted to the Sri Krishna Medical College and Hospital (SKMCH) on Friday after complaining of cold, convulsions and body ache. He passed away from AES at the SKMCH on Sunday. Soon after, four more cases of AES were reported along with one recovery.
The paediatrics intensive care unit (PICU) building at the hospital, which was meant to treat AES affected toddlers, remains under construction. Amidst the lockdown, 90 construction workers have been called in on an urgent notice to complete the building’s construction.
SKMCH Superintendent Dr Sunil Kumar Shahi told The Wire, “AES has caused one death while the second patient from East Champaran has been discharged from hospital. The departments of microbiology and paediatrics are keeping a vigil watch over cases of encephalitis. The 100 bed paediatric intensive care unit will soon be functional as fears over the coronavirus led to an absence of construction workers that delayed the completion of the building.”
In addition to this, each primary healthcare centre in the district was instructed to have a two-bed PICUs but amid an alarming rise in the threat of the coronavirus outbreak, these were turned into isolation wards. The scarcity of PICUs at the local level and the lack of a full-fledged functional PICU building at SKMCH remain unresolved.
Last year, over 150 children had died of AES and 647 cases had been reported. Locally known as chamki bukhar, AES has continuously struck northern districts in Bihar with Muzaffarpur emerging as the epicentre during summers since 1995. It has caused nearly 1,000 deaths in the last decade.
Encephalitis is the inflammation of brain cells (neural cells). The first death marks the onset of an umbrella syndrome that contains numerous symptoms making it a complex medical condition of Acute Encephalitis Syndrome (AES).
Public healthcare in a lurch
The parallel challenges for both the state government and health department exist in the form of the novel coronavirus outbreak and the dearth of protective gear needed by healthcare workers – doctors, paramedical staffs, nurse, ASHA workers, etc.
On March 23, 83 junior doctors at the Nalanda Medical College and Hospital (NMCH) under the banner of Junior Doctors’ Association (JDA) wrote to the NMCH superintendent for permission to go on a 15-day home quarantine as most of them had started to show symptoms of COVID-19 including sore throat, cough and fever. However, the request was not entertained because the truncated healthcare system could not afford to lose any members of its workforce. Later the doctors took medication and were provided with PPE kits considered insufficient for the existing workforce.
The NMCH has now been converted into a special hospital for COVID-19 patients – which was prompted criticism from doctors and medical staff workers due to its inadequate infrastructure to deal with critical patients. A doctor, on the condition of anonymity, said, “The NMCH Superintendent, who is about to retire, took an opportunity to receive plaudits from the state health department. The same NMCH’s emergency ward was flooded with water last year during monsoon and visuals of fishes swimming on its floor had emerged. How can a hospital with underfunded and dilapidated infrastructure be a special COVID-19 hospital?”
In another incident, the Superintendent of Jawaharlal Nehru Medical College Hospital (JNMCH), Bhagalpur instructed all interns to work with normal masks while working in the emergency and OPD wards ruling out the need for PPE kits and N95 masks during the treatment of coronavirus infected patients. The junior doctors requested to abstain from work without the provision of protective kits.
Service from ‘quacks’
As per WHO guidelines, health workers and doctors have been advised to use the National Institute for Occupational Safety and Health (NIOSH)-certified N95 mask. N95 mask is a three-layered mask – as opposed to the HIV kit in which the neck and the face remain uncovered – that can resist viral contamination as it sustains for six hours in the air.
As per a state government communiqué, Bihar’s healthcare is in dire need of five lakh PPE kits, 10 lakh N-95 masks, 10 lakh other varieties of masks but has only received about 4,000 kits, 10,000 N-95masks and just one lakh other masks. Against a demand for 10,000 RNA extraction kits, Bihar received only 250 and after demanding 100 ventilators it didn’t receive even one.
Last year, the state government admitted before the Supreme Court that it had a shortage of 57% doctors and 71% nurses. Despite this revelation, no new recruitment was carried out in the state. In 2019-20, the Bihar government, of a budget of Rs. 200,501.01 crore, spent Rs 9,157 crore on the health sector – a mere 5% of the budget.
According to the state health department, 1,618 samples have been collected so far across Bihar, of which 1,591 have tested negative which places Bihar in the list of states with one of the lowest testing rates. Among the 30 confirmed cases, one patient has died while two persons have been discharged from hospital after they tested positive after treatment. The highest number of cases have been reported by Munger (7), followed by Patna and Siwan with five cases each, followed by Gaya with four cases, Gopalganj and Nalanda with three cases each and Begusarai, Lakhisarai and Saran with one case each.
In a shocking move, the Siwan civil surgeon Dr Ashesh Kumar who was suspended by the state health department during the ongoing coronavirus outbreak because, in a March 25 letter, had asked medical officers of the districts to create a list of quacks (or jhola chhap doctors) so that their services could be used to fight the pandemic.
The state administration also struggled to take firm control of the situation and take adequate care of migrant workers who entered the state as a result of reverse migration. As per the state health department data till March 31, 4,16,031 migrant workers had entered the state of which only 5,162 were kept under watch and surveillance.
In contrast, the figure of migrant workers who had entered the state was 1.8 lakh according to the State Disaster Management Department’s principal secretary who informed the chief minister of the same during a high-level meet.
The state’s chief minister has kept vigil watch on officials across the state. In a recently taken decision, he directed all panchayat representatives of 8,392 panchayats to cooperate with the block and district officials to intensify the mass awareness drive and identify people who had come to the state from outside. Those who are suspected of being infected, in accordance with the CM’s orders, must be kept in isolation availing facilities made at the panchayat level.
The spree of sealing villages is also increasingly visible. The Siwan district administration was forced to seal 30 villages in three blocks of the district after four villagers, all with a travel history, tested positive for the novel coronavirus on Tuesday. Entry points of villages were barricaded and police forces deployed. Reports of people testing positive and villages being sealed has also come from districts of Nalanda, Begusarai, Munger and Gopalganj.
Saurav Kumar is an independent journalist.